As today is the first World Multiple Sclerosis Day, this article is dedicated to all sufferers and their care-givers.

MULTIPLE sclerosis (MS) is a condition in which there are multiple areas of scarring in the nerves in the brain and spinal cord. This results from patches of inflammation that affect the nerve and the protective myelin sheath which surrounds it and functions like the insulation around an electric wire.

Myelin is necessary for the electrical impulses to travel along the nerves in a proper manner. When MS occurs, the affected nerve cannot function properly. After the inflammation clears up, the nerve functions properly. Repair of the myelin occurs only in the early stages of MS. With each episode of inflammation, scars may form (sclerosis) and over time, the nerve gets permanently damaged.

The exact cause of MS is unknown. It is thought to be an auto-immune condition. The body’s immune system protects us from attacks by external agents like bacteria and viruses. It is thought that in MS, some parts of the immune system, called T cells, attack the myelin sheaths of the nerves of the brain and spinal cord. Some agent in the external environment like a virus may set off the attack in certain people with certain genetic predisposition. Though it is not inherited, close family members of a MS sufferer have an increased risk of getting the condition.

Once a person gets MS, it does not go away and the sufferer has to live with it for the rest of his or her life. MS is characterised by an uncertain and unpredictable course over time and in different sufferers.

The prevalence of MS in Malaysia is about two per 100,000 people. It affects more Chinese than it does Malays and Indians, as well as more females. The progressive course of MS and severe spinal relapses are the most important risk factors for the long term.

It is important for everyone to stay healthy but more so those with MS. The condition and occasionally the medicines prescribed may affect a sufferer’s mobility, eating and feelings. There are several ways in which one can stay well and improve their quality of life.

Medical and surgical care

As MS has multiple presentations, consultations with various specialists may be necessary to exclude other causes for the symptoms. Some of the specialities involved include neurology, ophthalmology, otorhinolaryngology (ear, nose and throat), gastroenterology, surgery, urology, psychiatry, physiotherapy and occupational therapy.

Preventive measures are needed in those who have balancing difficulties as there is increased risk of falls and personal injury, as well as in bedridden MS sufferers who are at risk of decubitus ulcers, lung collapse, pneumonia, and aspiration. Surgery may be needed to address symptoms like difficulty in swallowing, limb spasticity or contractures, or severe neuropathic pain.

The medicines used to treat MS include:

>Steroids which affect immunological functions like immune responses and inflammation, may hasten recovery from attacks but not the severity of the attacks.

>Immune-modulating drugs which decrease the ability of the immune cells to cause inflammation.

>Immunosuppressants which interfere with immunological function and can reduce inflammation.

These medicines reduce the relapse rate and its severity. If taken early, they may also reduce the rate at which disability occurs. Sufferers who are prescribed these medicines are taught how to take them and to manage the side effects, which commonly include flu-like illness and pain at the injection site.

Complementary medicines

As there are many gaps in the knowledge of MS, many sufferers and their caregivers use traditional and complementary medicines, often in addition to the prescribed medicines. It is vital to inform and discuss this with the doctor to avoid any drug interaction and adverse reactions.

Such traditional and complementary medicines include vitamin supplements, gingko biloba and acupuncture. Although there are no definitive studies that demonstrate the effectiveness of vitamin supplements in MS, their use is not contraindicated unless excess amounts are taken. The vitamin supplements used are vitamins A, B12, C, D and E.

As MS sufferers often have visual problems, vitamin A intake is likely to help those who also have vitamin deficiency. Vitamin C may be beneficial as it can reduce the risk of urinary tract infections which MS sufferers are more prone to. Vitamin D helps maintain bone density which may be low in MS sufferers as it is a side effect of the steroids prescribed, and would reduce the risk of osteoporosis. There are theoretical advantages to the use of vitamins B12 and E.

There are claims that gingko biloba helps improve memory. However, as it may cause clotting problems, it should be used cautiously or not at all in those taking blood thinning medicines such as aspirin. There are claims that acupuncture may reduce the severity of pain, fatigue, numbness, depression and anxiety.

Diet and physical activity

It has been shown that MS sufferers benefit from a balanced diet and regular aerobic exercises. The benefits include the maintenance or increase in muscle strength, physical endurance, protection of bone mass and better bladder and bowel control. In addition, there is a decrease in tiredness and depression.

There are no specific dietary restrictions in MS. Regular exercise is helpful. However, strenuous exercise and exposure to hot showers or saunas or excessive sunlight should be avoided. A dietician and physiotherapist would provide useful advice and assistance.

As in all chronic conditions, those with MS will experience varying emotions at different times of the illness. These include denial, fear, guilt, grief and depression.

Various factors contribute to the stress:

>Unpredictability – The diagnosis of MS is challenging and no one can predict its course, whether the symptoms will improve or worsen, change in nature or reappear in other parts of the body.

>Invisible symptoms –Some symptoms like weakness and fatigue are only known to the MS sufferer and no one else.

>Changes in mental function are experienced by about half of MS sufferers. They include memory difficulties, slow processing of information or solution of problems. 

>Mood swings are experienced by almost every MS sufferer. Emotions like laughter and crying are exaggerated or recur with minimal notice.

Although there is inevitably stress for MS sufferers, it can be managed by making adjustments. The MS sufferer has to recognise that it may not be possible to do all the things he or she previously did. The support of family and friends is crucial.

It is important to maintain and strengthen relationships with loved ones and friends as it enables everyone to adjust to the changes caused by MS. It is important to practise self-help as far as is possible and decline any activity if one is fatigued or feels weak.

A balanced diet and regular physical and mental exercise is beneficial. Relaxation techniques like massage, yoga and meditation are useful in reducing stress.

Rehabilitation

There are two objectives in rehabilitation. One is to restore lost function and the other is to preserve current function as the MS worsens. It usually involves activities of daily living, walking and maintaining balance. The rehabilitation programme is usually individualised.

Source: Dr.Milton Lum